The annual Pap test became a recommended standard for American women without ever having been subjected to controlled trials to estimate its efficacy and effectiveness. After more than 30 years of routine use, the Pap test fails to meet most of the generally accepted criteria for a mass screening program. The policy persists, however, because the nation's ideology supports the maximum utilization of new technologies; and special interest groups have promoted the test as the major weapon in the "War on Cancer." With some exceptions, this is a questionable allocation of public and private health resources.
Health information systems are complex combinations of methods of organization and computer technologies. They are idiosyncratic to each country. Chad's design of a national information system followed a process that can serve as a model for sustainable technology transfer--using consensual decision making and reinforcing administrative reforms while providing strong Ministry leadership and using technical assistance.
Pregnant teenagers who continue their schooling are compared with those who drop out. All the girls studied had access to a special educational program for young mothers. Factors affecting school attendance two months postpartum are analyzed. The authors critically discuss assumptions on which programs for teenage mothers are based and evaluated.
During the past 10 years, donors have recognized the need for major reforms to achieve sustainable development. Using non-project assistance they have attempted to leverage reforms by offering financing conditioned on the enactment of reform. The experience of USAID's health reform programmes in Niger and Nigeria suggest these programmes have proved more difficult to implement than expected. When a country has in place a high level of fiscal accountability and high institutional capacity, programmes of conditioned non-project assistance may be more effective in achieving reforms than traditional project assistance. However, when these elements are lacking, as they were in Niger, non-project assistance offers nothing inherently superior than traditional project assistance. Non-project assistance may be most effective for assisting the implementation of policy reforms adopted by the host government.
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